Provider Demographics
NPI:1699909044
Name:DECKER, MARQUITA R (MD, MPH)
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:R
Last Name:DECKER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 WALNUT ST
Mailing Address - Street 2:WARF BUILDING 753
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53726-2336
Mailing Address - Country:US
Mailing Address - Phone:608-577-0382
Mailing Address - Fax:
Practice Address - Street 1:610 WALNUT ST
Practice Address - Street 2:WARF BUILDING 753
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53726-2336
Practice Address - Country:US
Practice Address - Phone:608-577-0382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI55890-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program